Search Results (37)

Multiple Sclerosis (MS) is a chronic neurological disorder affecting the central nervous system that significantly impairs postural control and functional abilities. Robotic-assisted gait training mitigates this functional deterioration. This preliminary study aims to investigate the effects of a four-week gait training with the ExoAtlet II exoskeleton on static balance control and functional mobility in five individuals with MS (Expanded Disability Status Scale ≤ 2.5). Before and after the training, they were assessed in quiet standing under Eyes Open (EO) and Eyes Closed (EC) conditions and with the Timed Up and Go (TUG) test. Center of Pressure (CoP) Sway Area, Antero–Posterior (AP) and Medio–Lateral (ML) CoP displacement, Stay Time, and Total Instability Duration were computed. TUG test Total Duration, sit-to-stand, stand-to-sit, and linear walking phase duration were analyzed. To establish target reference values for rehabilitation advancement, the same evaluations were performed on a matched healthy cohort. After the training, an improvement in static balance with EO was observed towards HS values (reduced Sway Area, AP and ML CoP displacement, and Total Instability Duration and increased Stay Time). Enhancements under EC condition were less marked. TUG test performance improved, particularly in the stand-to-sit phase. These preliminary findings suggest functional benefits of exoskeleton gait training for individuals with MS. Full article

Background: Parkinson Disease (PD) is a progressive neurodegenerative disorder. Current therapeutic trials investigate treatments that can potentially modify the disease course. Testing their efficiency requires outcome assessments that are relevant to patients’ daily lives, which include gait and balance. Home-based examinations may enhance patient compliance and, in addition, produce more reliable results by assessing patients more regularly in their familiar surroundings. Objective: The objective of this pilot study was to assess the feasibility of a home-based outcome assessment designed to video record the Timed up and Go (vTUG) test via a study-specific smartphone app for patients with PD. Methods: 28 patients were recruited and asked to perform at home each week a set of three consecutive vTUG tests, over a period of 12 weeks using an app. The videos were subjected to a manual review to ascertain the durations of the individual vTUG phases, as well as to identify any errors or deviations in the setup that might have influenced the result. To evaluate the usability and user-friendliness of the vTUG and app, the System Usability Scale (SUS) and User Experience Questionnaire (UEQ) were administered to patients at the study end. Results: 19 patients completed the 12-week study, 17 of which recorded 10 videos or more. A total of 706 vTUGs with complete timings were recorded. Random Forest Regression yielded “time to walk up” as the most important segment of the vTUG for predicting the total time. Variance of vTUG total time was significantly higher between weeks than it was between the three consecutive vTUGs at one time point [F(254,23) = 6.50, p < 0.001]. The correlation between vTUG total time and UPDRS III total score was weak (r = 0.24). The correlation between vTUG and a derived gait subscore (UPDRS III items 9–13) was moderate (r = 0.59). A linear mixed-effects model revealed a significant effect of patient-reported motion status on vTUG total time. Including additional variables such as UPDRS III gait subscore, footwear and chairs used further improved the model fit. Conclusions: Assessment of gait and balance by home-based vTUG is feasible. Factors influencing the read-out were identified and could be better controlled for future use and longitudinal trials. Full article

Background/Objectives: Modern breast reconstruction has undergone substantial evolution, with implant-based, pedicled autologous, and free autologous techniques. The purpose of this study is to review the current state of the art in free autologous breast reconstruction, highlighting advancements in the types of flaps, donor site selection, techniques, and functional restoration. Methods: A literature review was conducted using PubMed to capture studies related to well-known free flaps that are used for breast reconstruction. Studies for each flap type were reviewed and sorted for inclusion into one of six categories: (1) clinical outcomes, (2) comparison studies of alternative flaps, (3) preoperative planning, (4) flap classifications and perfusion zones, (5) technique descriptions, and (6) time and cost analyses. Results: The majority (77%) of articles included were written on various types of abdominally based free flaps, including TRAM, DIEP, and SIEA flaps. These studies indicated an evolution in technique over time to minimize donor site morbidity, improve patient-reported and functional outcomes, improve efficiency, and expand clinical indications. The remaining 23% of articles discussed alternative flap choices, including PAP, TUG, S/IGAP, and LAP flaps. Studies highlighted technical challenges and the evolution of techniques to make these flaps more accessible, as well as how to combine flaps to expand clinical indications. Conclusions: Autologous breast reconstruction has evolved significantly, with advancements in techniques such as robotic-assisted surgery, multi-flap reconstruction, bipedicled flaps, and neurotization. This review highlights the current best practices while acknowledging ongoing challenges and the potential for future innovations in microsurgery, nerve regeneration, and personalized medicine, which hold promise for further refining outcomes. Full article

Background/Objectives: Multiple Sclerosis (MS) is a chronic neurological condition that impairs motor and sensory functions, particularly gait. Non-invasive neuromodulation techniques aim to enhance functional recovery and motor–cognitive outcomes, though their effectiveness remains debated. This study compared the effects of transcranial direct current stimulation (tDCS) and trans-spinal direct current stimulation (tsDCS), combined with robotic-assisted gait training (RAGT), on motor function and fatigue in people with MS (pwMS). Methods: This double-blind, randomized, sham-controlled clinical trial included 35 pwMS, who participated in 12 sessions of 20 min anodal tDCS (n = 11), cathodal tsDCS (n = 12), or sham treatment (n = 12), in addition to RAGT. Primary outcomes were assessed using the Timed 25-foot Walk (T25-FW), Timed Up and Go (TUG), walking speed, and Multiple Sclerosis Walking Scale-12 (MSWS-12). Fatigue was assessed with the Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS). ClinicalTrials number: NCT06121635. Results: Significant improvements in gait speed, T25-FW, MSWS-12, TUG scores, and fatigue (FSS) favored tDCS and tsDCS over sham stimulation. While no differences were found between tDCS and tsDCS, the tsDCS group showed a significant improvement in the FIS physical subscale compared to sham, unlike the tDCS group. Conclusions: tDCS and tsDCS, combined with RAGT, improve walking and reduce fatigue in pwMS, highlighting their potential in motor rehabilitation. Full article

Background/Objectives: The number of individuals with lower limb loss (LLL) is rising. Therefore, identifying the walking potential in individuals with LLL and prescribing adequate prosthetic systems are crucial. Various factors can influence participants’ walking ability, to different extents. The aim of the present study was to apply machine learning methods to develop a predictive mode. This model can assist rehabilitation and limb loss care teams in making informed decisions regarding prosthesis prescription and predicting walking ability in individuals with LLL. Methods: The present study was designed as a prospective cross-sectional study encompassing 104 consecutively recruited participants with LLL (average age 62.1 ± 10.9 years, 80 (76.9%) men) at the Medical Rehabilitation Clinic. Demographic, physical, psychological, and social status data of patients were collected at the beginning of the rehabilitation program. At the end of the treatment, K-level estimation of functional ability, a Timed Up and Go Test (TUG), and a Two-Minute Walking Test (TMWT) were performed. Support vector machines (SVM) were used to develop the prediction model. Results: Three decision trees were created, one for each output, as follows: K-level, TUG, and TMWT. For all three outputs, there were eight significant predictors (balance, body mass index, age, Beck depression inventory, amputation level, muscle strength of the residual extremity hip extensors, intact extremity (IE) plantar flexors, and IE hip extensors). For the K-level, the ninth predictor was The Multidimensional Scale of Perceived Social Support (MSPSS). Conclusions: Using the SVM model, we can predict the K-level, TUG, and TMWT with high accuracy. These clinical assessments could be incorporated into routine clinical practice to guide clinicians and inform patients of their potential level of ambulation. Full article

Background: Modern technologies are being applied to maintain and improve the functional performance of older adults. Fully immersive virtual reality (VR) combined with a scope of dual-task (DT) activities may effectively complement conventional physiotherapy programmes for seniors. The study aimed to compare the effectiveness of a fully immersive virtual reality (VR) environment combined with a scope of dual-task activities regarding balance in older women. Methods: Eighty women were recruited to the study protocol and, following randomisation, allocated to two equally sized groups, one pursuing conventional OTAGO exercises, the other one the VR-solutions-aided exercise programme combined with a scope of DT activities. Physiotherapy sessions spanned 6 weeks, each one lasting 60 min, three times a week, in both groups. Results: Homogeneity analysis of both study groups indicated no statistically significant differences at the first measurement point. After the intervention, both study groups achieved significantly improved scores on all tests. The VR + DT group obtained better results in dual-task gait and single-leg standing, whereas the greatest difference was observed during SLS CL (1.52 s vs. 2.33 s—difference 0.81 s 53.2% change, p = 0.001). The OTAGO group performed better in the TUG single-task gait (11.35 s vs. 12.60 s, p < 0.001) and in the Berg balance scale. Conclusions: The VR + DT training is effective in improving individual balance as well as in reducing fall risks. VR-assisted physiotherapy should complement conventional physiotherapy programmes (e.g., OTAGO). The benefits of applying VR solutions indicate that older women might well use this form of activity regularly under the guidance of a therapist or a family member. Full article

Autonomous berthing technology is a crucial engineering control problem within the ship intelligence system, encompassing a series of complex operations and technologies. Firstly, this paper analyses the research on autonomous berthing technology from a bibliometric point of view in order to obtain an overview of its past and present development and to outline the importance of this technology. Secondly, a literature review is conducted on each of the four aspects of autonomous berthing technology, namely sensing technology, berthing type, control method, and evaluation method, which can help to quickly understand the main aspects of this technology. Thirdly, the ship-assisting technologies needed to achieve autonomous berthing are discussed and analysed from six aspects: dynamic collision avoidance, path planning, path tracking, heading control, tug assistance, and shore-based systems. Finally, the challenges faced by the ship autonomous berthing technology on the way of development are summarised, and future development is projected. This paper aims to provide a more comprehensive perspective for analysing and researching ship autonomous berthing technology. Full article

Background: Recent studies have investigated the effects of exercise on the functional capacity of older adults; training with a balance exercise assist robot (BEAR) effectively improves posture. This study compared the clinical safety and efficacy of training using BEAR video games to conventional resistance training in older adults with cardiovascular disease (CVD). Methods: Ninety patients (mean age: 78 years) hospitalized due to worsening CVD were randomized to cardiac rehabilitation (CR) Group R (conventional resistance training) or Group B (training using BEAR). After appropriate therapy, patients underwent laboratory testing and functional evaluation using the timed up-and-go test (TUG), short physical performance battery (SPPB), and functional independence measure (FIM) just before discharge and 4 months after CR. The rates of CVD readmission, cardiac death, and fall-related fractures were monitored. Results: BEAR had no adverse effects during exercise. At 4 months, TUG and SPPB improved significantly in both groups, with no significant difference between them. FIM motor and the Geriatric Nutritional Risk Index were significantly improved in Group B versus Group R. There was no significant difference in cardiac events and fall-related fractures between the two groups. Conclusion: CR with BEAR is safe and comparable to conventional resistance training for improving balance in older adults with CVD. Full article

In order to address the dynamic changes in vessel preferences for berth lines caused by the deployment of shore-based power equipment in major ports and the collaborative scheduling problem of berthing and towing assistance, this paper quantifies the environmental costs of pollutants from the main engines of tugs and auxiliary engines of container ships using an environmental tax. Additionally, considering the economic costs such as vessel delay and shore power cable connection, a two-layer mixed-integer linear programming model is constructed using the task sequence mapping method. This model integrates the allocation of continuous berths at container terminals with coordinated towing scheduling for shore power selection. A solution approach is designed by combining the commercial solver (CPLEX) and the immune particle swarm optimization algorithm (IAPSO). The proposed scheme is validated using the example of the Nansha Phase IV Terminal at the Port of Guangzhou. The results show that compared to the traditional first-come-first-served and adjacent scheduling schemes, the collaborative scheduling scheme proposed in this paper reduces the total cost by 21.73%. By effectively utilizing berth resources and shore power equipment while densely arranging collaborative tasks and appropriately increasing the number of tugs, the port can convert the economic cost of leasing a small number of tugs (increased by 10.63%) into environmental benefits (decreased by 33.88%). This approach provides a reference for addressing nearshore pollution emissions in ports. Full article

For thousands of years, dogs have coexisted with humans and have been adopted as companion pets and working animals. The communication between humans and dogs has improved their coexistence and socialization; however, due to the nature of their activities, dogs and humans occasionally lose face-to-face contact. The purpose of this scoping review is to examine five essential aspects of current technology designed to support intentional communication between humans and dogs in scenarios where there is no face-to-face contact: (1) the technologies used, (2) the activity supported, (3) the interaction modality, (4) the evaluation procedures, and the results obtained, and (5) the main limitations. In addition, this article explores future directions for research and practice. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed when conducting the review. Scopus (Elsevier), Springer-Link, IEEE Xplorer, ACM Digital Library, and Science Direct were used as data sources to retrieve information from January 2010 to March 2022. The titles and abstracts were individually reviewed by the authors (L.R.-V., I.E.E.-C., and H.P.-E.), and the full articles were then examined before a final inclusion determination. 15 (3%) out of the 571 records that were obtained met the requirements for inclusion. The most used technologies for dogs are: (1) 71% of technologies focused on generating messages are wearable devices equipped with sensors (bite, tug, or gesture), (2) 60% of technologies focused on receiving messages are wearable devices equipped with vibrotactile actuators, and (3) 100% of technologies focused on bidirectional communication are videochats. 67% of the works are oriented to support search and assistance tasks. 80% of the works developed technology for one-way communication. 53% of the technologies have a haptic dog interaction modality, that is, there is an object that the dog must wear or manipulate in a certain way. All of the reported evaluations were pilot studies with positive feasibility results. Remote human-dog interaction technology holds significant promise and potential; however, more research is required to assess their usability and efficacy and to incorporate new technological developments. Full article

Background: Although stroke survivors can benefit from robotic gait rehabilitation, stationary robot-assisted gait training needs further investigation. In this paper, we investigated the efficacy of this approach (with an exoskeleton or an end-effector robot) in comparison to the conventional overground gait training in subacute stroke survivors. Methods: In a multicenter controlled clinical trial, 89 subacute stroke survivors conducted twenty sessions of robot-assisted gait training (Robotic Group) or overground gait training (Control Group) in addition to the standard daily therapy. The robotic training was performed with an exoskeleton (RobotEXO-group) or an end-effector (RobotEND-group). Clinical outcomes were assessed before (T0) and after (T1) the treatment. The walking speed during the 10-Meter Walk Test (10 MWT) was the primary outcome of this study, and secondary outcomes were the 6-Minute Walk Test (6 MWT), Timed Up and Go test (TUG), and the modified Barthel Index (mBI). Results: The main characteristics assessed in the Robotic and Control groups did not differ at baseline. A significant benefit was detected from the 10 MWT in the Robotic Group at the end of the study period (primary endpoint). A benefit was also observed from the following parameters: 6 MWT, TUG, and mBI. Moreover, patients belonging to the Robot Group outperformed the Control Group in gait speed, endurance, balance, and ADL. The RobotEND-group improved their walking speed more than the RobotEXO-group. Conclusion: The stationary robot-assisted training improved walking ability better than the conventional training in subacute stroke survivors. These results suggest that people with subacute stroke may benefit from Robot-Assisted training in potentiating gait speed and endurance. Our results also support that end-effector robots would be superior to exoskeleton robots for improving gait speed enhancement. Full article

Background: Balance impairment is a common disability in post-stroke survivors, leading to reduced mobility and increased fall risk. Robotic gait training (RAGT) is largely used, along with traditional training. There is, however, no strong evidence about RAGT superiority, especially on balance. This study aims to determine RAGT efficacy on balance of post-stroke survivors. Methods: PubMed, Cochrane Library, and PeDRO databases were investigated. Randomized clinical trials evaluating RAGT efficacy on post-stroke survivor balance with Berg Balance Scale (BBS) or Timed Up and Go test (TUG) were searched. Meta-regression analyses were performed, considering weekly sessions, single-session duration, and robotic device used. Results: A total of 18 trials have been included. BBS pre-post treatment mean difference is higher in RAGT-treated patients, with a pMD of 2.17 (95% CI 0.79; 3.55). TUG pre-post mean difference is in favor of RAGT, but not statistically, with a pMD of −0.62 (95%CI − 3.66; 2.43). Meta-regression analyses showed no relevant association, except for TUG and treatment duration (β = −1.019, 95% CI − 1.827; −0.210, p-value = 0.0135). Conclusions: RAGT efficacy is equal to traditional therapy, while the combination of the two seems to lead to better outcomes than each individually performed. Robot-assisted balance training should be the focus of experimentation in the following years, given the great results in the first available trials. Given the massive heterogeneity of included patients, trials with more strict inclusion criteria (especially time from stroke) must be performed to finally define if and when RAGT is superior to traditional therapy. Full article

Robotic technology has developed rapidly in recent years, and several robotic devices have been applied to improve physical, sensory, intellectual, psychological, and social functioning in the elderly and people with disabilities. In this study, we investigated the effects of EX1-assisted exercise in various environments on physical function, muscle strength, and walking efficiency in older adults. We designated four experimental conditions and randomly assigned participants to one of four groups: A (overground walking without an EX1), B (overground walking using the resistance mode of EX1), C (stair ascent using the assistance mode of EX1), and Group D (inclined treadmill walking using the assistance mode of EX1). A total of 60 community-dwelling elderly persons participated in 10 exercise intervention sessions for 4 weeks, and all participants were assessed before and after the exercise intervention. Physical function was measured by the 10-meter walk test for self-selected velocity (10MWT-SSV), short physical performance battery (SPPB), Berg balance scale (BBS), timed up and go (TUG), functional reach test (FRT), geriatric depression scale—short form (GDS-SF), and muscle strength of trunk and lower extremity. Cardiopulmonary metabolic energy efficiency was measured using a portable telemetric gas analyzer system. A significant increase in the 10MWT-SSV and TUG test was observed in groups B, C, and D. A statistically significant improvement in the SPPB and FRT was seen only in group D, and GDS-SF scores decreased significantly after exercise with an EX1 in groups B and D. Trunk and lower limb muscle strength increased more in the groups that exercised with EX1 assistance than those without an EX1, particularly in group B. The net metabolic energy costs and energy expenditure measurement during walking significantly improved in exercise groups C and D. The findings in this study support the application of the EX1 to physical activity and exercise to improve age-related changes in physical function, muscle strength, and walking efficiency among older adults. In addition, personalized exercise programs using different modes and training environments with an EX1 can enhance physical performance and walking efficiency in the elderly. Full article

The purpose of this article is to present a methodical approach to increasing the efficiency of a tug with an azimuth stern drive (ASD). The difficulties in the bow-to-bow (as a reverse tractor) operations of an azimuth stern-drive tug, while pulling at the assisted (towed) ship’s bow, are investigated through a parametric study. The authors’ original generic analytical model of a tug in a steady state is utilised. Various design and operation options are also compared, which cover the escort speed, hawser angle, and relative location of the towing point, among others. The latter also means a shift to stern-to-bow operation. The thruster power required and the remaining surplus for executing new alignment (steering) orders are assessed. The study is, thus, aimed at energy savings for the whole operation and, consequently, at long-term harbour-tug-fleet energy effectiveness. The basic output of the present research is the comparison of the behavioural and control patterns of various tug arrangements at a ship’s bow. The results of the study show a slight advantage for a midship winch tug working through her stern for bow operation (stern-to-bow) over the reverse tractor acting bow-to-bow. Comparing various tug designs or operation options is difficult due to complicated tug dynamics and statics patterns under the hawser action. Both relative and absolute towing forces have to be considered (a high relative force may result in a low absolute force, much less than ordered by the pilot), with some geometrical and safety constraints additionally. The practical implementation of the conducted research should cover the guidance and training rendered to tug masters in the scope of the operational limitations of a particular tug and towards the design or acquisition of the tug that is best-suited for a particular harbour operation. Full article

In the process of double-layer gas-assiste extrusion of a plastic micro-tube, the tugging effect caused by the pressure difference of the gas cushion layer inside the die has a great influence on the external dimensions of the micro-tube. Therefore, this study establishes a two-phase extrusion model based on compressible gas and incompressible melt. Ansys Polyflow finite element software was used to numerically simulate the extrusion process of the melt to analyze the effect of the gas cushion layer pressure difference on the micro-tube deformation. The research shows that the shrinkage rate of the micro-tube increases with increasing pressure of the outer cushion layer, and the degree of tube wall migration increases, too. In the process of extrusion, the first normal stress difference at the entrance of the gas cushion layer shows a significant effect on the melt velocity field distribution and the extruded micro-tube cross-sectional deformation. Full article